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Clinical Psychology > 4: Trauma > Flashcards

4: Trauma Flashcards

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1
Q

What was the original definition of trauma and what 2 factors led to being put into the DSM as PTSD?

A

OG = Physical wound

War veterans + increased attention to interpersonal violence + domestic/ sexual = idea of psychological distress

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2
Q

How was trauma first defined in the DSM and what are some issues with its then definition?

A 
Trauma = event outside + other xp range of usual human exp
Issues...
1. Vague
- usual human xp??
2. Subjective
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3
Q

How did the definition of trauma change in the 4th version of the DSM in 1994 and what were some of its criticism?

A

more explicit definition
- inclusive = 60% increase in diagnosis
- Trauma comes with fear, helplessness + horror
Criticism…
- excluded psychological integrity - there may have been no actual physical life threat but can still lead to trauma

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4
Q

How is trauma defined in the DSM now?

A

more explicit

  • need specific event which is stressful
  • only definition that is not theoretical
    1. need actual threat
  • directly
  • witness
  • learning
  • xp repeated exposure to details of threats (vicarious)
    2. - fear no longer needed since other emotions may be more prevalent eg shame, anger, guilt (Friedman et al, 2011)
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5
Q

The current definition of trauma exclude what type of vicarious trauma (criteria D)?

A
  • electronic media
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6
Q

What % of trauma patients are thought to be the result of hearing stories from traumatic survivors (vicarious) and what consequence does this have for people working with traumatic patients/ situations?

A

15-20%
Arvay + Uhlemann, 1996

  • need to help + accommodate for those working in the front like eg paediatricians/ nurses
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7
Q

The loss of loved ones = not considered traumatic. What issue does this bring up about the definition of trauma?

A

Is it possible to objectify what is traumatic?
- you cannot assume details + reactions will be the same
= individuals capacity to deal with event

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8
Q

How does considering individual capacity change what is considered to be traumatic?

A
  • event only traumatic if it overwhelms their capacity to deal with it
  • response is important more so than event
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9
Q

Why is individual capacity important for children in defining what is traumatic?

A
  • at least 2/3 of children xp adverse events (Anda + Felitti, 2003)
  • these adverse events considered not to be traumatic according to DSM (Verlinden et al, 2013)
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10
Q

What are the categories which are adverse childhood xp not considered traumatic by DSM?

A
  1. Emotional abuse
    - swearing, putting down, hostility
  2. Physical abuse
    - push, slap, hit

= physical + emotional neglect
- absence of something positive = love, reinforcement = develop symptoms of PTSD

  1. Parents being treated violently
  2. Substance abuse, mental illness/ parent imprisoned in home
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11
Q

How common is trauma?

A

very
- 50/80% of Americans exp at least once (Alonso et al, 2002)
- SA = higher base line due to prevalence of war + violence
(Atwoli et al, 2013)
- 64% at least one traumatic xp in life time - Europe (Darves-Bornoz et al, 2008)

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12
Q

What was found when analysing people who had experienced trauma in Italy?

A
  • 56% at least one traumatic events
  • avg = 4 traumatic events
  • trauma = from network events
  • hearing child abuse
    ISSUE:
  • some events more easy to asses
    eg Italy = catholic = less sexual abuse
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13
Q

What are some factors which can influence the statistics of traumas?

A
  1. can co-occur
    - eg: sexual violence + threatened death (Dong et al, 2004)
  2. gender differences in trauma (Briere + Elliott, 2003)
    - sexual violence higher in women
    - not shown in stats
  3. Geographical difference in trauma
    new Orleans = more likely to xp death of close fam + friend
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14
Q

What can the consequences of trauma be?

A
  • PTSD
  • Eating disorders
  • Depression
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15
Q

What are the symptoms of PTSD?

A
  • vivid re-xp
  • numbing feeling
  • avoid similar situations/ heightened sense of threat
  • intensified feelings about what happened
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16
Q

What are 2 explanations for what allows PTSD to persist as cause is unclear?

A
  1. Incomplete processing of event
    - lack memory capacity to process = memory detached
  2. meaning attached to xp
    - blaming self for something they couldn’t stop
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17
Q

What are the DSM criterion for PTSD?

A

Ca. stressor event
Cb. intrusion stressor - re-xp persistently
- need at least 2 like nightmares/ reminders
Cc. Avoidance
- conscious effort to avoid talking about it
- changes in life style to avoid exposure
Cd. Changes in cognition + mood
- self-blame
- flattened effect
Ce. Arousal + reactivity
- even after, arousal is heightened
Cf. Duration
Cg. Functional significance
Ch. Attribution
- so disturbance not due to medication or substance use etc

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18
Q

What is PTSD?

A

The continuous feeling of threat even when it is over

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19
Q

PTSD figures are lower than Trauma, but how prevalent is it in comparison?

A
  • 8.3% develop PTSD US (Kilpatrick et al, 2014)
  • 1-7% gen pop (Wittchen et al, 2011)
  • UK, France, Germany = highest prevalence
20
Q

What was found to be source of most trauma in UK, France + Germany and WHY?

A
  • Relationships
  • affluent countries have basic needs met so focus on relationships
    vs less affluent
21
Q

Rates of PTSD are higher in what populations?

A
  • women
  • War veterans (Fulton et al, 2015)
  • Child soldiers in Africa
  • Ambulance personnel
22
Q

What treatment is thought to be KEY for traumas and WHY?

A

Emotional processing

  • you have…
    1. Effective processing
  • emotional disturbance absorbed = no arousal when you remember
    2. Ineffective processing
  • arousal still when you remember
23
Q

How can you test is processing has taken place properly of traumatic events (emotional processing)?

A 
Probe methodology:
- expose them to a trigger
IF...
- negative reaction = not processed properly
- No reaction = processed properly
24
Q

What are the signs of ‘failed’ emotional processing?

A
  1. high lvl of arousal
  2. Intrusive thoughts + feelings
  3. Obsessions
  4. Flashbacks
  5. Nightmares
  6. Difficulty talking about event
25
Q

What is the key focus of treatment trauma: emotional processing?

A

How are you processing the event after the event?

- focus: changing of memory structure of event

26
Q

How are emotions and memory connected?

A

Amygdala - Emotions
Hippocampus - Memory
- close in proximity in the brain
- so when emotions are aroused, if strong enough = hippocampus also aroused

= SO degree of emotional arousal during event encoding correlates highly with recall (McGaugh, 2004)

27
Q

What did Payne et al, 2008 do suggesting the importance enduring emotional memory and sleep?

so sleep deals with emotions but what about the arousal….

Trauma can be effectively processed
= war children who had fragmentes dreams they would process it better = better recovery = linked to well-bein
Punamaki et al, 2005

A

part 1: Shown one 2 pictures of cars
- emotional object (image) = higher recognition (30min + 12hrs later)

Part 2: Sleep

  • Sleep group = emotional object consolidated = better recognition rate of emotional object
  • Awake group = memory faded

= sleep selectively preserving emotional objects

28
Q

Sleep deals with emotions but what about the arousal?

A

= REM important in preserving + removing arousal of event

  • memory being associated with other experience + contextualised
    = REM highly associative +
    = diffuse impact of emotions stimuli (Van der Hel, et al, 2011)
29
Q

What did punamaki et al (2005) find about war children who recovered from trauma?

A
  • those who had fragments dreams = better dealing with it

sleep + REM - emotions + arousal contextualised + diffuse impact of emotional stimuli

30
Q

What did Dekel + Bonanno (2013) find suggesting a link between trauma + memory?

A

49 adults who saw 9/11

  • resilient people were changing memory = becoming more benign
  • others recalled with unchanging memory = exp PTS
31
Q

How can PTS = PTSD?

-

A
  • og memory not effectively processed
  • ppl tend to avoid as trauma has a lot of emotional charge
  • effective processing requires emotional engagement w/ event Foa + Kozak 1986
  • compounded problem ad sleep is affected = sleep + avoidance = memory kept alive
32
Q

What is rumination?

A

repetitive self-focused thinking about the past

(Nolen-Hoeksema 1991)

  • rumination - avoidance strategy
    95% of PTSD ruminate Michale et al 2007
33
Q

Avoidance is key to ineffective processing. What avoidance techniques are there = persistent PTSD?

A
  1. Rumination
    - ruminating driving OGM
  2. Processing of anxiety
    - worry + ruminating = both verbal-conceptual
34
Q

How is autobiographical memory organised?

A

hierarchical organisation

  1. lifetime periods
  2. general events
  3. event-specific knowledge
    - as you move down, more emotions get attached
    - from abstract to concrete specific
35
Q

How is ruminating an avoidance strategy?

A
  • rumination = verbal conceptual process vs sensory - perceptual
  • PTS = affects the retrieval of autobiographical memories
    = Overgeneral autobiogrpahical memory (OGM)
  • PTSD = increased lvl of OGM (williams et al, 2007)
36
Q

What difference was found between the worries and those who were relaxed when asked to think about giving a presentation?

A
  • worry = little change in heart rate
  • relaxed = big changes in heart rate

worry similar to ruminating = avoidance = both verbal-conceptual

37
Q

Avoidance impedes effective emotional processing (not just verbal processing).
So what should the focus of therapy be and what are some issues to consider?

d

A

Focus on effective emotional processing

- Exposure to engage - but have to be sensitive

38
Q

What are the 2 different approaches to the treatment of PTSD?

A
  1. Prevention
    - immediate exposure before PTSD develops
    - within 72hrs
    - via psychological briefing
  2. Treatment after PTSD developed
    - pharmacological treatment
    - Trauma-focused psychological therapy
39
Q

What is Psychological debriefing?

A
  • encourage them to discuss them in as much detail as possible
  • looking for sensory detail
  • to help integrate memory
40
Q

What are some problems of psychological debriefing?

A
  • practically challenging if there are too many people
  • could actually increase change when they aren’t ready = negative consequences

Rose et al, 2002
those who received debriefing has greater risk of developing PTSD one year later

41
Q

What is trauma-focused psychological therapy?

A
  • let them process naturally
  • Help those who develop PTSD naturally
  • 2 views:
  1. Exposure view
    - to engage
  2. Cognitive view
    - works with meaning/ interpretation of event
42
Q

What are some exposure-view techniques?

A
  • written narrative
  • visualise
  • VR

whatever is appropriate for them

43
Q

What did Foa et al (1991) find and what does it support?

A

exposure therapy = not benefits initially

followed up = exposed therapy better response in PTSD vs alt therapy like coping skills training etc

44
Q

What is the cognitive view or trauma-focused psychological therapy?

A
  • trauma = negative appraisal about the event, self + world
    = negative thoughts = changes in behaviour to avoid
  • focus is on interpretation of event
    vis cognitive re-structuring
45
Q

What happens in cognitive re-structuring?

A
  • asked to xp event into new words
  • more rational
  • Trials shows trauma-focused CBT superior to stress management + no treatment (Bisson et al, 2007)

Clinical Psychology (17 decks)

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